[Pay-for-performance in healthcare: effects are uncertain]

Area of Science:

• Health Services Research
• General Practice
• Healthcare Policy

Background:

• A pay-for-performance (P4P) scheme was implemented in UK general practices in 2004.
• Dutch health authorities are considering a similar P4P policy.
• Quality of care in Dutch general practice has been a long-standing concern.

Purpose of the Study:

• To evaluate the impact of the UK's P4P scheme on the quality of patient care.
• To inform the decision-making process for potential P4P implementation in Dutch general practice.

Main Methods:

• Analysis of the UK's P4P policy introduced in 2004.
• Assessment of effects on patient care quality, particularly for hypertension, asthma, and diabetes.
• Identification of unintended consequences and pre-existing quality improvement trends.

Main Results:

• Financial incentives for healthcare providers did not improve care quality for British patients with hypertension.
• A temporary positive effect was observed for patients with asthma and diabetes.
• The quality of general practice care was already improving prior to the P4P policy implementation, and unintended consequences were noted.

Conclusions:

• Extensive P4P schemes may not be effective in improving general practice quality, especially for conditions like hypertension.
• Dutch health authorities should carefully consider the UK's experience, including unintended consequences.
• Collaboration between general practitioners and health insurance companies, focusing on trust and facilitation, may be more beneficial than P4P.